Prior to regulation by the FDA, over-the-counter medicine in this country was largely a creation of small businesses. There was a large variety of so-called “patent medicine,” each a proprietary blend of – what?

The term “patent medicine” has nothing to do with being issued a patent. The term refers to a letters patent, which is essentially permission to use a royal endorsement. Most patent medicines were not actually patented mainly because the promoters did not want to disclose their ingredients.

Instead, such products were branded and their brand heavily marketed.

As a result the ingredients of these patent medicine products were largely unknown. Compounding pharmacists were familiar with the ingredients, however, and often sold cheap knockoffs, making it all the more important for promoters to protect and promote their brand.

A study presented recently at a meeting of the American Chemical Society reports the analysis of 50 different patent medicine from a collection in the Henry Ford Museum in Dearborn Mich. The results will probably not surprise you:

“Many patent medicines had dangerous ingredients, not just potentially toxic substances like arsenic, mercury and lead, but cocaine, heroin and high concentrations of alcohol.”

The heavy metals were likely largely contaminants, but sometimes they may have been deliberate. Mercury and arsenic, for example, were used at the time as treatments for syphilis. The other common ingredients were often the true active ingredients. Heroin is a narcotic and would have been effective at treating pain. Cocaine is an addictive substance – which makes it good for repeat business. And alcohol is could certainly take the edge off of many complaints, at least in the short term.

Ingredients were largely not advertised, although sometimes a main ingredient like heroin was part of the promotion. Often the implication given was that a special blend of natural herbs were the main ingredients, but that was just for show.

None of these products were the result of careful research. The manufacturers had no need for such expenses. They were motivated to make grandiose claims, promote their brands, to include cheap ingredients, and to include an ingredient that would give a good “kick” to their customers so that they would feel it was working.

While we may look back at such products as quaint and hokey, there is essentially no difference between them and the supplements that are all the rage today. After the 1994 Dietary Supplement Health and Education Act that essentially removed supplements from FDA regulation, we have had a return of the patent medicine era.

Today you can find countless products, heavily branded and marketed, with grandiose claims, often cut with something like caffeine or another legal stimulant to give a nice kick, and marketed without the need to provide any evidence for safety or efficacy.

There are two main differences, however. The first is that the ingredients need to be disclosed. The second is that promoters cannot claim to cure diseases, but have to restrict their claims to “structure function” claims. This is a massive loophole, however, as they can make claims that their product supports some biological function with the clear implication of what it is treating.

Airborne is a great example. This is heavily brand marketed, with the notion that it was created by a school teacher, as if that is a credible source for a medicine. The claim is that it will support your immune system, so take it before you get on a plane to prevent contracting a cold or other infection from all the close contact. In reality it’s just a mixture of vitamins and minerals, and there is no reason to think that it will support the immune system to prevent colds.

Today anyone can combine a random mixture of cheap ingredients – herbs, vitamins, or minerals – and then imply whatever health claims they wish for their mixture as long as they are slightly careful in how they word the claims.

This is a simple result of market forces in the absence of effective regulation. There is no reason to think that the snake oil herbs and supplements of today would be any different from that patent medicines of previous centuries.

7 Responses to “What Was in Patent Medicines”

Another delightful blog post Dr Novella, I really enjoyed reading this. On a side note, this article is a poignant reminder of the times I would wonder over to crazed, conspiracy mongering ideologues’ websites such as Alex Jones. Their stores would always contain a plethora of pseudo-medicine that the government doesn’t want you to know about/take, because if everybody took them there would be no disease! etc…
But scrolling on down to the bottom I’d always notice this lovely disclaimer I doubt they enjoy having:
“The Food and Drug Administration has not evaluated these statements. These products are not intended to diagnose, treat, cure or prevent any disease.”

It beautifully highlights how even though on the surface these people claim to despise all governing authorities and large corporations because they are corrupt, they are still jumping on the supplement bandwagon and selling this rubbish at super inflated prices.

Pharmaceutical companies are bad, very bad, so come over to our shop and buy our supplements for hundreds of dollars!

I can’t help but wonder about the age of the couple in the “Wizard Oil” and what a couple of similar age would look like today. There would be a difference and it would most certainly not be due to improvements in Snake oil.

A trip to any “Health” or “Natural” foods store and an increasing number of pharmacies, will show that snake oil is very much alive and well. With the loss of heroin and cocaine, more effective marketing is required to get people to use this stuff. With the promotion of the useless by the media, there is enough confirmation bias to make anything “work”. As for the alcohol, the cost benefit ratio is far better at my local Pub.

The first thing I noticed about that Hamlin’s wizard oil advertisement is how creepy the couple look, and that is the feeling I get from advertising from that time period. Today, the couple would be horseback riding or at the very least lying in bed with perfectly done hair and makeup. I thought that products like wizard oil were primarily for topical use, although that image appears to imply that it is being taken orally. I’m sure that it works equally well for all indications regardless of route of administration.

Dr Novella and most readers of this post probably know this, but I always find it interesting that the majority of people using the ‘snake oil’ category for useless pseudoscientific products or methods do not know its origins. Snake oil was a traditional Chinese remedy for pain and inflammation brought over by laborers doing railroad construction. Dr. Richard Kunin had it analyzed in 1989 where it was found to contain about 20% EPA an omega-3 oil along with several other fatty acids that have shown efficacy for many conditions in double blind studies. The Chinese water snake water having the higher omega-3 levels than the rattlesnake oil in the picture. Yes, there is always some conflicting data, but most studies show positive effects. I wonder if it was overlooked because Dr. Kunin is more of an ‘alternative’ MD and Orthomolecular doctor….so the real ‘snake oil’ story is ignored by the mainstream. But, facts are facts. The New England Journal of Medicine was unwilling to publish it, but the Western Journal of Medicine did. You could almost say that nowadays you need a doctor’s prescription for ‘snake oil’ if your doctor prescribes Lovaza. a prescription ‘fish oil’ marketed by GSK that is mostly omega-3 EPA, the main ‘active ingredient’ in snake oil. There is over $1 Billion in annual sales in the US. Would it be more accurate to say that over a Billion Dollars a year of Lovaza ‘snake oil’ is sold, but you need a prescription? There are pharmaceutical grade OTC fish oils with the same or stronger potency than Lovaza that are a sixth of the price. So, could you say the supplement world sells pharmaceutical grade ‘snake oil’ for less? Scientific American, Nov 1, 2007 article “Snake oil salesmen were onto something” has a good summary. I was back at my Pharmacy School last week and it still had the same old glass display cases filled with ‘snake oil’ remedies that were there 37 years ago.

“Yes, there is always some conflicting data, but most studies show positive effects.”

‘Most studies’ of what exactly? The data are pretty weak for any indication even if speaking of omega three fatty acids broadly, and clinical data is nonexistent for the specifics you are talking about with regards to snake oil and pain and inflammation from something like railroad work. You mention Lovaza specifically, and even it has only 1 approved indication: as adjunct to diet for people with high triglycerides, and that isn’t for lack of trying. There have been many studies looking at other indications, such primary prevention of cardiovascular events, heart failure, etc, and they are collectively negative for those indications. I’m not even going to get into extrapolating such data to something like a non-standardized snake oil, but there are obvious problems with doing so.

You also allude to some type of conspiracy against certain practitioners for the NEJM not publishing a particular study in their journal, instead of the more obvious answer: most studies (the vast majority) are rejected from good journals, and bad journals accept most papers (and there is the spectrum in between). So there are no conclusions that can be drawn from a given study being rejected by a particular journal just as we can’t conclude anything from a given applicant being rejected from admission to a particular school.

That’s a pretty sketch story for SciAm; I’m disappointed. It reads like it should be in Discover, or maybe Popular Science…

Traditionally, snake oil was applied externally, rubbed onto the skin. Even if we’re to accept the efficacy of Omega 3’s straight as read – and that’s a big “if” – to link anecdotes about oil used on the skin to studies that review the effect of feeding animal subjects diets that were high in Omega 3…